e-infrastruktur som stöd för hemtjänsten

The annual cost of home care services of transport in Falun/Borlänge, is now at 31 million kronor. It is clear from previous research that it is possible to reduce these costs through a restructuring of the existing home-help service. The restructuring aims to have a higher proportion of older people, who are in need of care, to live in special accommodation, in order to reduce transport costs. Therefore there is a need for systems that allow home-help service to plan their operations in such a way that transport is working as efficiently as possible. Through better planning, there are profits to be done. The rewards are not only of an economic nature but also include a reduced environmental impact, better working environment, improving road safety, and better service. One way to achieve this is to give home-help service personnel better navigation aid when they move between the customers. The thesis describes such a solution through a developed prototype based on a standardized interaction between a planning and a navigation service. The thesis describes such a solution through a developed prototype based on a standardized interaction between a planning and a navigation service. Development work has also been a first step in developing a standardized information infrastructure for home-help service. The purpose of the thesis is, on the basis of theory and the experience we have acquired through the development of the prototype, to discuss general issues which are of interest when developing standardized information infrastructure.

Self-Service Business Intelligence verktyg – möjligheter ochbegränsningar : En jämförelse av teorier om Self-Service Business Intelligence verktyg och praktiska resultat av verktyget PowerPivot

Inom Business Intelligence har begreppet Self-Service Business Intelligence (Self-Service BI) vuxit fram. Self-Service BI omfattar verktyg vilka möjliggör för slutanvändare att göra analyser och skapa rapporter utan teknisk support. Ett av dessa verktyg är Microsoft PowerPivot.På Transportstyrelsens Järnvägsavdelning finns behov av ett Self-Service BI-verktyg. Vi fick i uppdrag av Sogeti att undersöka om PowerPivot var ett lämpligt verktyg för Transportstyrelsen. Målet med uppsatsen har varit att testa vilka tekniska möjligheter och begränsningar PowerPivot har samt huruvida PowerPivot är användbart för Transportstyrelsen.För att få en djupare förståelse för Self-Service BI har vi kartlagt vilka möjligheter och begränsningar med Self-Service BI-verktyg som finns beskrivna i litteraturen. Vi har sedan jämfört dessa med våra testresultat vilket har varit syftet med uppsatsen.Resultatet av testerna har visat att Transportstyrelsens Järnvägsavdelning initialt behöver teknisk support för att använda PowerPivot. Testerna har även visat att vissa av Transportstyrelsens krav inte kan uppfyllas. Detta minskar användbarheten för Transportstyrelsen.Vidare har vi kommit fram till att Self-Service BI inte alltid är enkelt att använda för slutanvändare utan teknisk support. Resultatet visar även att det krävs en BI-infrastruktur för att enkelt skapa rapporter med god kvalitet och högsta möjliga korrekthet.

Kvinnors upplevelse av planerad hemförlossning i Skandinavien : Women´s experience of planned home birth in the Scandinavian countries

Background: In Sweden and Norway planned home birth is not included in the health care system. In Denmark women with expected low risk birth have the right to choose home birth. Registrations of home births in the Nordic countries are not completed and women’s experiences of planned home birth in Scandinavian context are not earlier described.Objective: The aim of this study was to describe women’s experiences of planned home birth in the Scandinavian countries.Design: Inductive content analysis. Fifty-three Scandinavian women who have experienced planned home birth have replied an open question in a questionnaire. Findings: In the analysis five categories and twelve subcategories emerged. The categories were, to feel secure, experiences of support, being in control, harmony and insecurity. The women felt secure and calm in their own homes. They felt being in control, secure, support and trust in the midwife, relatives and the own body. What worried the women most in presence of the delivery was that the midwife should not be present. Keywords: Home birth, experiences, women.

The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants : study protocol for a randomized controlled trial

Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff. Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480

Life situations and the care burden for stroke pa­tients and their informal caregivers in a prospective cohort study

Background. The purpose of this study was to analyse whether the parallel life situation between stroke patients and their informal caregivers (dyads) shown in cross-sectional studies prevails also in a longitudinal perspective. Methods. A total of 377 Swedish stroke patients, aged ‡65 years, and their 268 informal caregivers were followed from hospital admission and one year on. Analyses were based on patient interviews, functional ability (MMSE) score, Nottingham Health Profile (NHP) score, Hospital Anxiety and Depression (HAD) score, self-rated health score, and the Gothenburg Quality of Life (GQL) activity score. Similar information was obtained by postal questionnaires from informal caregivers, also including information on the nature and amount of assistance provided and on Caregiver Burden (CB) score. Results. Before index admission informal caregivers provided care on average 5 h per week and after discharge 11 h per week (P < 0.0001). Support volume was associated with patient sex (more for men), low patient’s functional ability, low received municipal social service support, closeness of patient–caregiver relation, and short distance to patient’s home. Significant positive associations within the dyads were found for HAD anxiety score (P < 0.0001), total NHP score (P < 0.0001), and GQL activity score (P < 0.0001) after adjustment for patient’s age, sex, functional ability, and patient–caregiver relationship. CB score increased with amount of informal caregiver support, patient’s age, and with low functional ability and low amount of municipal social service support. All these associations were constant across time. Conclusions. There was an association within the dyads regarding anxiety score, NHP score, and activity score. CB score was generally high.

Parenthood in transition : Somali-born parents' experiences of and needs for parenting support programmes

BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting. METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied. RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities. CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.

Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

The Importance of Work-Life Balance Opportunities and Support from the Perspective of Nursing Stu-dents in Dalarna, Sweden

There is a shortage of nurses leading to challenges in recruitment in Sweden and many other countries. Especially for less populated regions recruitment can be chal-lenging. Nurses often face difficulties with work-life balance (WLB). This study aims to identify the importance of WLB opportunities and support that make a work-place attractive from the perspective of nursing students studying in Dalarna. A questionnaire was distributed via email to 525 students enrolled in the nursing bach-elor program at Dalarna University. They were asked to rate the importance of 15 sub questions regarding WLB opportunities and support. These sub questions were asked in order to analyze the importance of 15 components regarding WLB oppor-tunities and support. 196 students (37 percent) answered the questionnaire. Three WLB components, working from home, childcare and rooms for breastfeeding, were found to be not important to nursing students studying in Dalarna. This was reason-able due to the profession of nursing and the WLB support provided by the Swedish government. Cultural factors, such as the organization being positive towards using WLB opportunities and support, were more important than structural factors, such as the possibility to work part-time. Moreover, to have a manager that is supportive towards using WLB opportunities and support was found to be the most important factor and having workplace practical support such as childcare was found least im-portant. Furthermore, contrary to the expected results, no statistical significance was found on the influence on the importance of all combined relevant WLB opportuni-ties and support by the sociodemographic variables; gender, semester of studies, age, having children, months of work experience and work experience in the healthcare sector. However, nine individual components were found to be influ-enced by one or more sociodemographic variables. Therefore, some recommenda-tions on how to target specific groups of individuals were made. However, the con-clusion of the study is that, regardless of the sociodemographic variables and gov-ernmental support, organizations should offer new nurses opportunities and support to gain a balance between work and life, especially in terms of cultural factors.